Provider Demographics
NPI:1669629499
Name:RONALD E LEACH
Entity type:Organization
Organization Name:RONALD E LEACH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-965-8141
Mailing Address - Street 1:PO BOX 41830
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93140-1830
Mailing Address - Country:US
Mailing Address - Phone:805-965-8141
Mailing Address - Fax:
Practice Address - Street 1:616 N MILPAS ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-3027
Practice Address - Country:US
Practice Address - Phone:805-965-8141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28185122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB28185-01OtherDENTI-CAL
CA006287OtherBLUE CROSS